“One Chance to get it right’ End of Life Care Wirral University Teaching Hospital.

“One Chance to get it right’

End of Life Care

Wirral University Teaching

Hospital

90% of inpatients are recognised as dying 48 hours before death and 100% of these

have a personalised care plan

This is to be achieved by by September 2015

The TeamSue Peters: Day to Day Leader

Clare Brown: End of Life Transform Lead Nurse

Claire Ashton: Quality and Safety Analyst

Heather Aitken, Liz Watkins, Denise Farrance

Janice Evans: Specialist Nursing Lead Wirral CT

Nick Mamo, Sophie Duckworth

Geraldine McCaffery: pharmacy

Anne McGinnity: Divisional Manager

Melanie Maxwell: Associate Medical Director

Cathy Lewis-Jones: Palliative Care Consultant

Alan Pugh: Administrator L+D,HROD

Jill Galvani: Director of Nursing/Executive Sponsor

Aim / Outcome 

Primary Drivers Secondary Drivers

90% of inpatients are recognised as dying 48 hours before death and 100% of these have a

personalised care plan (by September 2015)

Knowledge of prognostic indicators of dying

Communication with patient, carers and family; understanding patients’ needs

and wishes

Individualised Care plan

Clinical Audit

Aide memoir prompt for Care of Dying

Education and training healthcare workers

Handover of nursing and medical staff

Priorities for Care of the Dying person

Bereavement Support

Advance Care Planning

Amber Care Bundle

Mortality audit

Critical incidents

Coding/EoL Data measurement

Methods

• Pilot wards 33/36• Assessment/Prompt Tool/Powerpoint presentation• E-learning module/Podcast• WUTH monthly Pilot meetings• E-communication• Baseline Audit completed in Pilot Ward Areas.• Communication with Ward Managers, Consultants,

trainees• Training log/Top up training

Oct 2014

Nov 2014

Dec 2014

Jan 15 2014

Feb 2015

Mar 2015 Apr 2015

May 2015

June 2015

July 2015

Aug 2015

Sept 2015

50.0% (6/12)

14.3% (1/7)

50.0% (9/18)

40.0% (6/15)

41.7% (5/12)

21.4%% (3/14)

31.3% (5/16)

22.2% (2/9)

30% (3/10)

66.7% (10/15)

33.3% (3/9)

44.4% (4/9)

Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-150%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Outcome measure: Patients recognised as entering the dy-ing phase =>48 hours prior to death.

Target 90% by Sept 2015.

Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-150%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Recognition that the patient was entering the dying phase doc-umented within the notes.

Oct 2014

Nov 2014

Dec 2014

Jan 15 2014

Feb 2015

Mar 2015

Apr 2015

May 2015

June 2015

July 2015

Aug 2015

Sept 2015

58.3%(7/12)

71.4%(5/7)

83.3% (15/18)

86.7%(13/15)

75.0%(9/12)

50.0%(7/14)

68.8% (11/16)

100% (9/9)

70.0% (7/10)

80.0% (12/15)

77.8% (7/9)

88.9% (8/9)

Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-150%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Recognition that the patent is dying communicated with the pa-tient and their relatives/carers.

Patient

Rela-tive

  Oct 2014

Nov 2014

Dec 2014

Jan 15 2014

Feb 2015

Mar 2015 Apr 2015

May 2015

June 2015

July 2015

Aug 2015

Sept 2015

Patient 25.0% (1/4)

40.0% (2/5)

37.5% (3/8)

50.0% (4/8)

16.7% (1/6)

25.0% (1/4)

50.0% (2/4)

50.0% (2/4)

100% (4/4)

66.7% (2/3)

50.0% (1/2)

Relative/ carer

85.7%(6/7)

83.3% (5/6)

92.9% (13/14)

100% (12/12)

100% (9/9)

80.0% (8/10)

100% (11/11)

100% (8/8)

100% (9/9)

100% (12/12)

100% (7/7)

100% (8/8)

Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-150%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Evidence of discussion regarding treatment options with the pa-tient and their relative/carers.

Patient

Relative

  Oct 2014

Nov 2014

Dec 2014

Jan 15 2014

Feb 2015

Mar 2015

Apr 2015

May 2015

June 2015

July 2015

Aug 2015

Sept 2015

Patient 55.6%(5/9)

40.0% (2/5)

36.4% (4/11)

72.7% (8/11)

55.6% (5/9)

57.1% (4/7)

55.6% (5/9)

80.0% (4/5)

100% (5/5)

88.9% (8/9)

83.3% (5/6)

100% (4/4)

Relative/ carer

83.3% (10/12)

83.3% (5/6)

93.3% (14/15)

100.0% (13/13)

80.0% (8/10)

100.0% (14/14)

92.3% (12/13)

100% (9/9)

90.0% (9/10)

100% (14/14)

88.9% (8/9)

100% (9/9)

Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-150%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%Preferred place of care documented in the notes.

Oct 2014

Nov 2014

Dec 2014

Jan 15 2014

Feb 2015

Mar 2015

Apr 2015

May 2015

June 2015

July 2015

Aug 2015

Sept 2015

25.0% (3/12)

42.9% (3/7)

27.8% (5/18)

33.3% (5/15)

16.7% (2/12)

35.7% (5/14)

25.0% (4/16)

44.4% (4/9)

80.0% (8/10)

53.3% (8/15)

30.8% (4/13)

66.7% (6/9)

Oct

-14

Nov-14

Dec-14

Jan-1

5

Feb-15

Mar-1

5

Apr-15

May-

15

Jun-1

5

Jul-1

5

Aug-15

Sep-15

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Patients preferences and wishes regarding treatment documented in the notes.

Oct 2014

Nov 2014

Dec 2014

Jan 15 2014

Feb 2015

Mar 2015

Apr 2015

May 2015

June 2015

July 2015

Aug 2015

Sept 2015

50.0% (6/12)

42.9% (3/7)

38.9% (7/18)

42.9% (6/14)

25.0% (3/12)

28.6% (4/14)

31.3% (5/16)

44.4% (4/9)

70.0% (7/10)

73.3% (11/15)

46.2% (6/13)

88.9% (6/9)

Any obstacles/challenges?

• Time constraints• Movement of Staff/ Agency Staff• Leadership on ward• Availability of stakeholders to attend

meetings and progress with project work• No designated time allocated for project

work

Key lessons?

• Collaborative working• Working within a designated time frame• Development of new skills• Networking • Staff motivated from Pilot Wards• Use of Board rounds• Communication, Care planning and

Documentation